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Ibarra F, Sawtelle S, Cruz M. Emergency Medicine Physician Residents' Perceptions of Emergency Medicine Clinical Pharmacists' Involvement in Their Training. Ann Pharmacother 2024:10600280241253383. [PMID: 38816985 DOI: 10.1177/10600280241253383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Although the clinical impact of emergency medicine clinical pharmacists (EMCPs) on patient care outcomes is well documented, their educational impact on resident physicians' training is not. OBJECTIVE To further highlight the utility of EMCPs, this study evaluated emergency medicine (EM) resident physicians' perceptions of EMCPs' involvement in their training. METHODS A voluntary, anonymous web-based survey was sent by email to all 44 EM resident physicians in July 2022. The survey included multiple choice, 5-point Likert scale, and free response questions derived from Accreditation Council for Graduate Medical Education pharmacotherapy competency-based milestones. RESULTS Thirty-six of the 44 (82%) residents completed the survey and all 10 PGY-4 class residents completed the survey. Nearly half of the respondents (44.4%) reported they consulted/interacted with the EMCPs 3 to 5 times per week and this number increased with the level of training. Respondents most often consulted the EMCPs to obtain medication indications, antibiotic dosing, pediatric dosing, and contraindications. Overall, respondents primarily reported strongly agree to all survey questions. Nearly all respondents strongly agreed the EMCPs are an important part of the patient care team and provide education that is different from what a supervising physician provides. All respondents who completed the pharmacy elective strongly agreed the elective was valuable and strongly recommended other residents to complete it. CONCLUSION AND RELEVANCE Respondents reported EMCPs are an important part of the patient care team, play a significant role in their training, and provide education that is different from what a supervising physician provides. Our findings encourage other institutions to leverage physicians' views of EMCPs to expand their service line.
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Affiliation(s)
- Francisco Ibarra
- Department of Pharmacy Services, Community Regional Medical Center, Fresno, CA, USA
- University of California, San Francisco Fresno Medical Education Program, University of California, San Francisco, Fresno, CA, USA
| | - Stacy Sawtelle
- University of California, San Francisco Fresno Medical Education Program, University of California, San Francisco, Fresno, CA, USA
| | - Mallory Cruz
- Department of Pharmacy Services, Community Regional Medical Center, Fresno, CA, USA
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Nguyen MH, Gordon K, Reachi B, Bair J, Chauv S, Fontaine GV. Cost-avoidance associated with implementation of an overnight emergency medicine pharmacist at a Level I Trauma, Comprehensive Stroke Center. Am J Emerg Med 2024; 82:63-67. [PMID: 38805940 DOI: 10.1016/j.ajem.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/28/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024] Open
Abstract
AIM To investigate the cost-avoidance associated with implementation of an overnight emergency medicine pharmacist (EMP) through documented clinical interventions. DESIGN Retrospective evaluation of prospectively tracked interventions in a single Level I Trauma, Comprehensive Stroke Center, from November 25, 2020 through March 12, 2021 during expanded emergency medicine service hours (2300-0700). INTERVENTIONS One of 45 clinical patient-care recommendations associated with cost-avoidance were available to be selected and documented by the EMP; more than one intervention was allowed per patient, though one clinical intervention could not be counted as multiple items. Documented services were associated with monetary cost avoidance based upon available literature assessing pharmacy clinical interventions. Differences in time from imaging to systemic thrombolytics and percentage of patients meeting door-to-alteplase benchmarks were compared with and without the availability of EMPs. RESULTS Overnight EMPs documented 820 interventions during 107 overnight shifts with a cost avoidance of $612,974. The most common interventions were bedside monitoring (n = 127; $50,694), drug information consultation (97; $11,269), and antimicrobial therapy initiation and streamlining (95; $60,101). When categorizing interventions, 378 (46%; $292,484) were input as hands-on care, 216 (26%; $94,899) as individualization of patient care, 135 (17%; $25,897) as administrative and supportive tasks, 84 (10%; $121,746) as adverse drug event prevention, and 7 (1%; $77,964) as resource utilization. All patients (n = 6) with an acute ischemic stroke during the evaluation period received systemic thrombolytics ≤45 min in the presence of EMPs compared with 50% receiving thrombolytics ≤45 min without EMPs. CONCLUSIONS Expanded overnight coverage by EMPs provided clinical bedside pharmacotherapy expertise to critically ill patients otherwise not available prior to study implementation. Clinical interventions were associated with substantial cost-avoidance.
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Affiliation(s)
- Mark H Nguyen
- Department of Pharmacy, Intermountain Medical Center, Intermountain Health, Salt Lake City, UT, United States of America.
| | - Kyle Gordon
- Department of Pharmacy, Intermountain Medical Center, Intermountain Health, Salt Lake City, UT, United States of America
| | - Breyanna Reachi
- Department of Pharmacy, Intermountain Medical Center, Intermountain Health, Salt Lake City, UT, United States of America
| | - Jeremy Bair
- Department of Pharmacy, Intermountain Medical Center, Intermountain Health, Salt Lake City, UT, United States of America
| | - Stephanie Chauv
- Department of Pharmacy, Intermountain Medical Center, Intermountain Health, Salt Lake City, UT, United States of America
| | - Gabriel V Fontaine
- Department of Pharmacy, Intermountain Medical Center, Intermountain Health, Salt Lake City, UT, United States of America
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Wira CR, Kearns T, Fleming-Nouri A, Tyrrell JD, Wira CM, Aydin A. Considering Adverse Effects of Common Antihypertensive Medications in the ED. Curr Hypertens Rep 2024:10.1007/s11906-024-01304-5. [PMID: 38687403 DOI: 10.1007/s11906-024-01304-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE OF REVIEW To evaluate the adverse effects of common antihypertensive agents utilized or encountered in the Emergency Department. RECENT FINDINGS All categories of antihypertensive agents may manifest adverse effects, inclusive of adverse drug reactions (ADRs), drug-to-drug interactions, or accidental overdose. Adverse effects, and specifically ADRs, may be stratified into the organ systems affected, might require specific time-sensitive interventions, could pose particular risks to vulnerable populations, and may result in significant morbidity, and potential mortality. Adverse effects of common antihypertensive agents may be encountered in the ED, necessitating that ED systems of care are poised to prevent, recognize, and intervene when adverse effects arise.
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Affiliation(s)
- Charles R Wira
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA.
- Yale Acute Stroke Program, Section of Vascular Neurology, Department of Neurology, New Haven, CT, USA.
| | - Thomas Kearns
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
| | - Alex Fleming-Nouri
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
| | - John D Tyrrell
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
- Department of Pharmacy, Yale New Haven Hospital, New Haven, CT, USA
| | | | - Ani Aydin
- Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT, 06519, USA
- Section of Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT, USA
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García González D, Teixeira-da-Silva P, Salvador Sánchez JJ, Sánchez Serrano JÁ, Calvo MV, Martín-Suárez A. Discrepancies in Electronic Medical Prescriptions Found in a Hospital Emergency Department: A Prospective Observational Study. Pharmaceuticals (Basel) 2024; 17:460. [PMID: 38675420 PMCID: PMC11054114 DOI: 10.3390/ph17040460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/26/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
The medication in an electronic prescribing system (EPS) does not always match the patient's actual medication. This prospective study analyzes the discrepancies (any inconsistency) between medication prescribed using an EPS and the medication revised by the clinical pharmacist upon admission to the observation area of the emergency department (ED). Adult patients with multimorbidity and/or polypharmacy were included. The pharmacist used multiple sources to obtain the revised medication list, including patient/carer interviews. A total of 1654 discrepancies were identified among 1131 patients. Of these patients, 64.5% had ≥1 discrepancy. The most common types of discrepancy were differences in posology (43.6%), commission (34.7%), and omission (20.9%). Analgesics (11.1%), psycholeptics (10.0%), and diuretics (8.9%) were the most affected. Furthermore, 52.5% of discrepancies affected medication that was high-alert for patients with chronic illnesses and 42.0% of medication involved withdrawal syndromes. Discrepancies increased with the number of drugs (ρ = 0.44, p < 0.01) and there was a difference between non-polypharmacy patients, polypharmacy ones and those with extreme polypharmacy (p < 0.01). Those aged over 75 years had a higher number of prescribed medications and discrepancies occurred more frequently compared with younger patients. The number of discrepancies was larger in women than in men. The EPS medication record requires verification from additional sources, including patient and/or carer interviews.
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Affiliation(s)
- David García González
- Pharmaceutical Sciences Department, Universidad de Salamanca, 37007 Salamanca, Spain; (M.V.C.); (A.M.-S.)
- Pharmacy Service, León University Healthcare Complex, 24008 Leon, Spain
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Paulo Teixeira-da-Silva
- Pharmaceutical Sciences Department, Universidad de Salamanca, 37007 Salamanca, Spain; (M.V.C.); (A.M.-S.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Juan José Salvador Sánchez
- Emergency Department, Salamanca University Healthcare Complex, 37007 Salamanca, Spain; (J.J.S.S.); (J.Á.S.S.)
| | - Jesús Ángel Sánchez Serrano
- Emergency Department, Salamanca University Healthcare Complex, 37007 Salamanca, Spain; (J.J.S.S.); (J.Á.S.S.)
| | - M. Victoria Calvo
- Pharmaceutical Sciences Department, Universidad de Salamanca, 37007 Salamanca, Spain; (M.V.C.); (A.M.-S.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
| | - Ana Martín-Suárez
- Pharmaceutical Sciences Department, Universidad de Salamanca, 37007 Salamanca, Spain; (M.V.C.); (A.M.-S.)
- Institute of Biomedical Research of Salamanca (IBSAL), 37007 Salamanca, Spain
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Mercer KJ, Brizzi MB, Burhoe DN, Senn JM, Rohani R, Nowicki DN, Januszka JE, Wordlaw R, Durham SH. Expanding expedited partner therapy and HIV prophylaxis in the emergency department. Am J Health Syst Pharm 2024; 81:279-290. [PMID: 38142223 DOI: 10.1093/ajhp/zxad322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Indexed: 12/25/2023] Open
Abstract
PURPOSE Sexually transmitted infections (STIs) continue to have a disproportionate impact on individuals belonging to sexual, gender, and racial minorities. Across the nation, many emergency medicine pharmacists (EMPs) possess the skills and knowledge to expand the provision of expedited partner therapy (EPT) for STIs and provide HIV prophylaxis within existing practice frameworks. This report serves as a call to action for expanded provision of EPT and HIV prophylaxis by EMPs and highlights current barriers and solutions to increase pharmacist involvement in these practice areas. SUMMARY Emergency medicine pharmacy practice continues to expand to allow for limited prescribing authority through collaborative practice agreements (CPAs). In recent years, CPA restrictions have been changed to facilitate treatment of more patients with less bureaucracy. This report addresses the unique challenges and opportunities for expanding EPT and HIV pre- and postexposure prophylaxis provision by pharmacists in emergency departments (EDs). Furthermore, current strategies and treatments for EPT, such as patient-delivered partner therapy and HIV prophylaxis, are discussed. Pharmacist involvement in STI treatment and HIV prevention is a key strategy to increase access to high-risk populations with high ED utilization and help close current gaps in care. CONCLUSION Expanding EMP provision of EPT and HIV prophylaxis may be beneficial to reducing the incidence of STIs and HIV infection in the community. CPAs offer a feasible solution to increase pharmacist involvement in the provision of these treatments. Legislative efforts to expand pharmacist scope of practice can also contribute to increasing access to EPT and HIV prophylaxis. With these efforts, EMPs can play an essential role in the fight against STIs and HIV.
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Affiliation(s)
- Kevin J Mercer
- University of Texas at Austin College of Pharmacy, Austin, TX
- Department of Pharmacy, Houston Methodist West Hospital, Katy, TX, USA
| | - Marisa B Brizzi
- Department of Pharmacy, University of Cincinnati Health, Cincinnati, OH, USA
| | - Devon N Burhoe
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, GA, USA
| | - Joshua M Senn
- Department of Pharmacy, UofL Health - UofL Hospital, Louisville, KY
- Department of Emergency Medicine, University of Louisville School of Medicine, Louisville, KY, USA
| | - Roxane Rohani
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL
- Captain James A. Lovell Federal Health Care Center, North Chicago, IL, USA
| | - Diana Nicole Nowicki
- UNC Health, Chapel Hill, NC, and UNC Eshelman School of Pharmacy, Chapel Hill, NC, USA
| | - Jenna E Januszka
- University of Illinois Chicago College of Pharmacy, Chicago, IL, USA
| | - Rudijah Wordlaw
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
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Samuels-Kalow ME, Tassone R, Manning W, Cash R, Davila-Parrilla L, Hayes BD, Porter S, Camargo CA. Analysis of a Medication Safety Intervention in the Pediatric Emergency Department. JAMA Netw Open 2024; 7:e2351629. [PMID: 38214929 PMCID: PMC10787317 DOI: 10.1001/jamanetworkopen.2023.51629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Importance Strategies to reduce medication dosing errors are crucial for improving outcomes. The Medication Education for Dosing Safety (MEDS) intervention, consisting of a simplified handout, dosing syringe, dose demonstration and teach-back, was shown to be effective in the emergency department (ED), but optimal intervention strategies to move it into clinical practice remain to be described. Objective To describe implementation of MEDS in routine clinical practice and associated outcomes. Design, Setting, and Participants This mixed-methods interrupted time series study of MEDS was conducted April 2021 to December 2022 in an academic pediatric ED using a hybrid type 1 design. Parents and guardians of children aged 90 days to 11.9 years who were discharged with acetaminophen, ibuprofen, or both were eligible for inclusion in the quantitative portion. Clinicians from a diversity of role groups (attending physician, resident, and nurse) were eligible for the qualitative portion. Exposures The study was conducted in 5 stages (baseline, intervention 1, washout, intervention 2, and sustainability phases). The 2 intervention phases taught clinical staff the MEDS intervention using different implementation strategies. During the intervention 1 phase, in-depth interviews were conducted until thematic saturation was reached; results were analyzed using thematic analysis. Interviews informed intervention 2 phase interventions. Main Outcomes and Measures The primary outcome was any error (defined as dosing or frequency error) at a 48- to 72-hour follow-up phone call. Results There were 256 participants (median [IQR] child age, 1.7 [3.0-7.0] years; median [IQR] parent and guardian age, 36.0 [31.0-41.0] years; 200 females among parents and guardians [78.1%]) who consented and completed follow-up. At baseline, 44 of 68 participants (64.7%) made an error compared with 34 of 65 participants (52.3%) during intervention 1, 31 of 63 participants (49.X%) during intervention 2, and 34 of 60 participants (57.X%) during sustainability. After adjustment for language and health literacy, the adjusted odds ratio for error during the combined intervention phases was 0.52 (95% CI, 0.28-0.97) compared with baseline. Conclusions and Relevance This study found that both MEDS intervention phases were associated with decreased risk of error and that some improvement was sustained without active intervention. These findings suggest that attempts to develop simplified, brief interventions may be associated with improved medication safety for children after discharge from the ED.
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Affiliation(s)
- Margaret E Samuels-Kalow
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Randall Tassone
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - William Manning
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Rebecca Cash
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Laura Davila-Parrilla
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
- Ponce Health Sciences University School of Medicine, Ponce, Puerto Rico
| | - Bryan D Hayes
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Stephen Porter
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston
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Morley H, Seabury R, Parsels K, Miller C, Darko W, Schrader J, Meola G. Preparation/administration of push-dose versus continuous infusion epinephrine and phenylephrine: A simulation. Am J Emerg Med 2023; 74:135-139. [PMID: 37832396 DOI: 10.1016/j.ajem.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/18/2023] [Accepted: 10/01/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Hypotension is a common problem in the emergency department (ED) and intensive care unit (ICU) and can increase risk for poor outcomes. Many EDs/ICUs utilize epinephrine and phenylephrine to treat hypotension and these medications are most often administered as a continuous infusion (CI). Push-dose (PD) is the administration of small medication doses as intermittent intravenous pushes (IVPs). There is limited information comparing the time required to prepare and administer PD versus CI and errors have been reported when preparing and administering these medications at bedside. This simulation study sought to estimate preparation and administration times and preparation and errors with PD and CI epinephrine and phenylephrine when prepared by an ED/ICU pharmacist. METHODS This crossover simulation study took place in a simulation center at an academic medical center and utilized a multi-venous intravenous training arm kit equip with an 18-gauge intravenous line, an extension tubing set, and a luer-lock adapter. The primary outcome was total preparation and administration time in seconds. The secondary outcome was major preparation and administration errors, defined as errors causing a five-fold or greater overdose. RESULTS In total, 16 pharmacists participated, including nine ED and seven ICU pharmacists. PD had faster total preparation and administration time and administration time, but not preparation time; PD showed an approximate 70 s decrease in total preparation and administration time versus CI. PD had more major preparation and administration errors and six PD preparations (18.8%, 6/32) had at least one major preparation and administration error. CI, on the other hand, had no major preparation and administration errors. DISCUSSION This simulation found faster total preparation and administration time with PD versus CI epinephrine and phenylephrine, but also found that PD had more major preparation and administration errors. Dilutional errors during medication preparation were the cause of 83.3% (5/6) of our overdoses. CONCLUSION This simulation study showed that ED/ICU pharmacists had faster median total preparation and administration times for PD epinephrine and phenylephrine versus CI, but PD also had more preparation and administration errors.
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Affiliation(s)
- Hannah Morley
- SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, United States of America
| | - Robert Seabury
- SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, United States of America; SUNY Upstate Medical University, Syracuse, NY 13210, United States of America
| | - Katie Parsels
- SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, United States of America.
| | - Christopher Miller
- SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, United States of America; SUNY Upstate Medical University, Syracuse, NY 13210, United States of America
| | - William Darko
- SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, United States of America; SUNY Upstate Medical University, Syracuse, NY 13210, United States of America
| | - Joshua Schrader
- SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, United States of America
| | - Gregory Meola
- SUNY Upstate University Hospital, 750 E Adams St, Syracuse, NY 13210, United States of America; SUNY Upstate Medical University, Syracuse, NY 13210, United States of America
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Dunn TE, Desai KJ, Krajewski MP, Jacobs DM, Lu CH, Paul S, Paladino JA. Pharmacists and transitions of care from emergency department to home. THE AMERICAN JOURNAL OF MANAGED CARE 2023; 29:715-719. [PMID: 38170487 PMCID: PMC10926005 DOI: 10.37765/ajmc.2023.89473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVES To determine the impact of a pharmacist-led telephone outreach program among patients discharged from the emergency department (ED) to home. STUDY DESIGN We conducted a randomized controlled study from February to November 2019 at a tertiary care academic medical center. METHODS At ED discharge, participants were randomly assigned to usual care (controls) or usual care plus the pharmacist's review (intervention group). Eligible individuals included those being discharged from the ED to home with 8 or more medications. A pharmacist telephoned patients in the intervention group within 48 to 96 hours after ED discharge. The medications in the patient's record from the ED were compared with what the patient was taking at home. Discrepancies were communicated to the primary provider via fax or telephone. The primary outcome was overall health care utilization including unplanned hospital readmissions or ED visits within 30 days of discharge. The effect of the intervention on the number of acute events was analyzed using a Poisson regression model adjusting for relevant baseline characteristics. RESULTS Of 90 eligible participants, 45 patients each were in the intervention and control groups. A total of 26 patients (58%) in the intervention group were reached, and 56 interventions were provided by the pharmacists. There was no significant difference between groups for overall health care utilization (adjusted risk ratio [aRR], 1.01; 95% CI, 0.50-2.06; P = .96), hospitalizations (aRR, 0.20; 95% CI, 0.02-2.18; P = .19), and ED visits (aRR, 1.24; 95% CI, 0.56-2.79; P = .59). CONCLUSIONS A pharmacist-led telephone outreach program conducted after ED discharge was not associated with a change in health care utilization.
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Affiliation(s)
| | | | | | | | - Chi-Hua Lu
- School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, The State University of New York, 3435 Main St, 344 Abbott Hall, Buffalo, NY 14214. . ORCID: 0000-0001-9647-4363
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Justen M, Edelman EJ, Chawarski M, Coupet E, Cowan E, Lyons M, Owens P, Martel S, Richardson L, Rothman R, Whiteside L, O'Connor PG, Zahn E, D'Onofrio G, Fiellin DA, Hawk KF. Perspectives on and experiences of emergency department-initiated buprenorphine among clinical pharmacists: A multi-site qualitative study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 155:209058. [PMID: 37149149 DOI: 10.1016/j.josat.2023.209058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 01/05/2023] [Accepted: 05/01/2023] [Indexed: 05/08/2023]
Abstract
INTRODUCTION Clinical pharmacists are well positioned to enhance efforts to promote emergency department (ED)-initiated buprenorphine to treat opioid use disorder (OUD). Among clinical pharmacists in urban EDs, we sought to characterize barriers and facilitators for ED-initiated buprenorphine to inform future implementation efforts and enhance access to this highly effective OUD treatment. METHODS This study was conducted as a part of Project ED Health (CTN-0069, NCT03023930), a multisite effectiveness-implementation study aimed at promoting ED-initiated buprenorphine that was conducted between April 2017 and July 2020. Data collection and analysis were grounded in the Promoting Action on Research Implementation in Health Services (PARIHS) framework to assess perspectives on the relationship between 3 elements: evidence for buprenorphine, the ED context, and facilitation needs to promote ED-initiated buprenorphine. The study used an iterative coding process to identify overlapping themes within these 3 domains. RESULTS The study conducted eight focus groups/interviews across four geographically disparate EDs with 15 pharmacist participants. We identified six themes. Themes related to evidence included (1) varied levels of comfort and experience among pharmacists with ED-initiated buprenorphine that increased over time and (2) a perception that patients with OUD have unique challenges that require guidance to optimize ED care. With regards to context, clinical pharmacists identified: (3) their ability to clarify scope of ED care in the context of unique pharmacology, formulations, and regulations of buprenorphine to ED staff, and that (4) their presence promotes successful program implementation and quality improvement. Participants identified facilitation needs including: (5) training to promote practice change and (6) ways to leverage already existing pharmacy resources outside of the ED. CONCLUSION Clinical pharmacists play a unique and critical role in the efforts to promote ED-initiated buprenorphine. We identified 6 themes that can inform pharmacist-specific interventions that could aid in the successful implementation of this practice.
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Affiliation(s)
- Marissa Justen
- Yale School of Medicine, 333 Cedar St, New Haven, CT 06510, United States of America.
| | - E Jennifer Edelman
- Yale School of Medicine, Department of Internal Medicine, Edward S. Harkness, Building A, 4th floor 367 Cedar Street, New Haven, CT 06510, United States of America
| | - Marek Chawarski
- Yale School of Medicine, Department of Psychiatry, 300 George St #901, New Haven, CT 06511, United States of America
| | - Edouard Coupet
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Ethan Cowan
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America
| | - Michael Lyons
- University of Cincinnati College of Medicine, 3230 Eden Ave, Cincinnati, OH 45267, United States of America
| | - Patricia Owens
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Shara Martel
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Lynne Richardson
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America
| | - Richard Rothman
- John Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, United States of America
| | - Lauren Whiteside
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, United States of America
| | - Patrick G O'Connor
- Yale School of Medicine, Department of Internal Medicine, Edward S. Harkness, Building A, 4th floor 367 Cedar Street, New Haven, CT 06510, United States of America
| | - Evan Zahn
- Yale New Haven Hospital, 20 York Street, New Haven, CT 06510, United States of America
| | - Gail D'Onofrio
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - David A Fiellin
- Yale School of Medicine, Department of Internal Medicine, Edward S. Harkness, Building A, 4th floor 367 Cedar Street, New Haven, CT 06510, United States of America; Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
| | - Kathryn F Hawk
- Yale School of Medicine, Department of Emergency Medicine, 464 Congress Ave, Suite 260, New Haven, CT 06519, United States of America
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Poremba M, Champa K, Reichert E. Evaluating reduction in medical costs associated with pharmacists' presence in the emergency department using a novel cost avoidance framework. Am J Health Syst Pharm 2023; 80:S111-S118. [PMID: 36525567 DOI: 10.1093/ajhp/zxac376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023] Open
Abstract
PURPOSE The purpose of this study was to evaluate the cost avoidance associated with emergency medicine pharmacist (EMP) presence in the emergency department (ED) using a novel cost avoidance framework. SUMMARY This single-center, retrospective, observational study examined EMP interventions from November 1, 2021, through March 31, 2022. EMPs prospectively selected up to 10 shifts in which to log interventions during the study period. Interventions were categorized into 25 cost avoidance categories, 10 of which incorporated recently proposed probability variables. All categories were organized into 4 broad cost avoidance domains, including resource utilization, individualization of patient care, adverse drug event prevention, and hands-on care. During the study period, 894 interventions were logged, which accounted for $143,132 in cost avoidance (lower probability value of $124,186, upper probability value of $168,858), with a median cost avoidance per shift of $1,671 (interquartile range, $1,025 to $2,451). On the basis of 240 shifts, the estimated annual total cost avoidance per pharmacist was extrapolated to be $401,040. CONCLUSION While the mean cost avoidance of $161.10 per intervention observed in our study was less than that in prior cost avoidance studies due to the conservative and potentially more realistic estimates used, implementation of this cost avoidance framework still showed substantial cost avoidance associated with EMP presence in the ED.
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Affiliation(s)
- Matthew Poremba
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Kelsey Champa
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Erin Reichert
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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11
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Summerlin JA, Wang KM, McMahon AJ, Lund JA. Effect of a pharmacist-based toxicology consult service on appropriate use of intravenous N-acetylcysteine for acetaminophen toxicity: A retrospective cohort study. Int J Crit Illn Inj Sci 2023; 13:54-59. [PMID: 37547194 PMCID: PMC10401558 DOI: 10.4103/ijciis.ijciis_88_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 08/08/2023] Open
Abstract
Background Incorporating clinical pharmacists on the medical team has been associated with fewer medication errors and increased error interception. Due to the logistical complexities of the intravenous (IV) N-acetylcysteine (NAC) regimen for acetaminophen toxicity, many opportunities for medication errors exist. A pharmacist-based toxicology consultation service was implemented at our institution, allowing pharmacists to formally aid in the management of toxicology patients throughout their hospital admission, including those with acetaminophen toxicity. The purpose of this study was to evaluate the effect of a house-wide pharmacist-based toxicology consult service on errors associated with IV NAC treatment for patients admitted with acetaminophen toxicity. Methods A retrospective, pre-post cohort study was conducted on patients who received IV NAC for acetaminophen toxicity. The intervention evaluated was the implementation of a pharmacist-based toxicology consult service, known as the pharmacy toxicology team. The primary end point was the incidence of an error associated with IV NAC. An error was defined as the composite of inappropriate dose, administration rate, initiation, continuation, or discontinuation. Results Eighty-four patients were included; 30 patients in the pregroup, and 54 patients in the postgroup. Fewer patients experienced an error in the postgroup compared to the pregroup (30% vs 63%, P = 0.003). Conclusion The implementation of this unique pharmacist-based toxicology consult service was associated with fewer patients experiencing an error related to IV NAC therapy for acetaminophen toxicity. Application of this data may aid in the justification for development of clinical pharmacist-based toxicology consult services at other institutions.
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Affiliation(s)
- Jonathan A Summerlin
- Department of Pharmacy, Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Kellie M Wang
- Department of Pharmacy, Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Andre J McMahon
- Department of Pharmacy, Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Jeremy A Lund
- Department of Pharmacy, Sarasota Memorial Health Care System, Sarasota, Florida, USA
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12
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Awad NI, Hayes BD. Beyond pharmacy: Innovations in professional development outside of the discipline. Am J Health Syst Pharm 2023; 80:176-178. [PMID: 36378148 DOI: 10.1093/ajhp/zxac347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Nadia I Awad
- Department of Pharmacy Robert Wood Johnson University Hospital New Brunswick, NJ, USA
| | - Bryan D Hayes
- Department of Pharmacy Massachusetts General Hospital Boston, MA.,Division of Medical Toxicology Department of Emergency Medicine Harvard Medical School Boston, MA, USA
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13
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Weant KA, Acquisto NM, Doyno CR, Gregory H, Rech MA, Schlobohm CJ, Smith AP, Won KJ. Development of an emergency medicine pharmacy intensity score tool. Am J Health Syst Pharm 2023; 80:215-221. [PMID: 36322132 DOI: 10.1093/ajhp/zxac328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Emergency medicine pharmacists (EMPs) have been demonstrated to have a positive impact on patient outcomes in a variety of clinical scenarios in the emergency department (ED), yet their distribution across the nation is suboptimal. An emergency medicine pharmacy intensity score tool (EMPIST) would not only facilitate the quantification of EMP staffing needs and ideal resource deployment times, but would also allow practitioners to triage patient care activities. The purpose of this investigation was to develop an EMPIST and evaluate its relationship to EMP activities. METHODS This was a multicenter, prospective, observational analysis of an EMPIST developed by practicing EMPs. EMPs prospectively documented their clinical activities during usual care for patients in their ED. Spearman's rank-order correlation was used to determine any correlation between the EMPIST and pharmacist activities. RESULTS In total, 970 EMP activities and 584 EMPIST items were documented in 352 patients by 7 EMPs across 7 different EDs. The most commonly documented EMP interventions performed were bedside monitoring (12.7%), initiation of nonantimicrobial therapy (12.6%), and antimicrobial therapy initiation and streamlining (10.6%). The total EMPIST was found to significantly correlate with EMP activities, and this correlation was consistent across both "diagnostic/presentation" and "medication" items (P < 0.001 for all comparisons). CONCLUSION The EMPIST significantly correlated with EMP activities, with consistent correlation across all subgroups. Its utilization has the potential to enhance bedside clinical practice and optimize the deployment of limited EMP services. Additional investigations are needed to examine the validity of this tool and identify any relationship it may have to patient outcomes.
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Affiliation(s)
- Kyle A Weant
- Department of Clinical Pharmacy and Outcome Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Nicole M Acquisto
- Department of Pharmacy, University of Rochester Medical Center, Rochester, NY.,Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Cassandra R Doyno
- Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, USA
| | - Haili Gregory
- Department of Pharmacy Services, University of Florida Health Shands, Gainesville, FL, USA
| | - Megan A Rech
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL.,Department of Emergency Medicine, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Cory J Schlobohm
- Department of Pharmacy Services, Alta Bates Summit Medical Center, Oakland, CA, USA
| | - Andrew P Smith
- Department of Pharmacy Services, Scripps Mercy Hospital, San Diego, CA, USA
| | - Kimberly J Won
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA, and Providence Mission Hospital, Mission Viejo, USA
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14
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Hamidah KF, Rahmadi M, Meutia F, Kriswidyatomo P, Rahman FS, Izzah Z, Zulkarnain BS, Aminde LN, Alderman CP, Yulistiani, Suprapti B. Prevalence and factors associated with potentially inappropriate medication and medication complexity for older adults in the emergency department of a secondary teaching hospital in Indonesia. Pharm Pract (Granada) 2022; 20:2735. [PMID: 36793915 PMCID: PMC9891774 DOI: 10.18549/pharmpract.2022.4.2735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/19/2022] [Indexed: 12/13/2022] Open
Abstract
Background Older adults experience progressive decline in various organs and changes in pharmacokinetics and pharmacodynamics of the drugs in the body which lead to an increased risk of medication-related problems. Potentially inappropriate medications (PIMs) and medication complexity are key factors contributing to adverse drug events in the emergency department (ED). Objective To estimate the prevalence and investigate the risk factors of PIMs and medication complexity among older adults admitted to the ED. Methods A retrospective observational study was conducted among patients aged > 60 years admitted to the ED of Universitas Airlangga Teaching Hospital in January - June 2020. PIMs and medication complexity were measured using the 2019 American Geriatrics Society Beers Criteria® and Medication Regimen Complexity Index (MRCI), respectively. Results A total of 1005 patients were included and 55.0% (95% confidence interval [CI]: 52 - 58%) of them received at least one PIM. Whereas, the pharmacological therapy prescribed to older adults had a high complexity index (mean MRCI 17.23 + 11.15). Multivariate analysis showed that those with polypharmacy (OR= 6.954; 95% CI: 4.617 - 10.476), diseases of the circulatory system (OR= 2.126; 95% CI: 1.166 - 3.876), endocrine, nutritional, and metabolic diseases (OR= 1.924; 95% CI: 1.087 - 3.405), and diseases of the digestive system (OR= 1.858; 95% CI: 1.214 - 2.842) had an increased risk of receiving PIM prescriptions. Meanwhile, disease of the respiratory system (OR = 7.621; 95% CI: 2.833 - 15.150), endocrine, nutritional and metabolic diseases (OR = 6.601; 95% CI: 2.935 - 14.847), and polypharmacy (OR = 4.373; 95% CI: 3.540 - 5.401) were associated with higher medication complexity. Conclusion In our study, over one in every two older adults admitted to the ED had PIMs, and a high medication complexity was observed. Endocrine, nutritional and metabolic disease was the leading risk factors for receiving PIMs and high medication complexity.
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Affiliation(s)
- Khusnul Fitri Hamidah
- Department of Pharmacy, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.
| | - Mahardian Rahmadi
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.
| | - Farah Meutia
- Master of Clinical Pharmacy Program, Faculty of Pharmacy, Universitas Airlangga Surabaya, Indonesia.
| | - Prihatma Kriswidyatomo
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Universitas Airlangga, Emergency Department, Universitas Airlangga Teaching Hospital, Surabaya, Indonesia.
| | - Firman Suryadi Rahman
- Doctoral Program of Public Health, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia.
| | - Zamrotul Izzah
- Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands.
| | | | - Leopold N Aminde
- School of Medicine, Griffith University, Gold Coast, QLD, Australia.
| | - Christopher Paul Alderman
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.
| | - Yulistiani
- Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.
| | - Budi Suprapti
- Department of Pharmacy, Universitas Airlangga Teaching Hospital, Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia.
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15
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Mahmoud MI, Maatoug MM, Jomaa AAAFA, Yousif M. Sudanese Medical Doctors' Perceptions, Expectations, Experiences and Perceived Barriers Towards the Roles of Clinical Pharmacists: A Cross-Sectional Study. Integr Pharm Res Pract 2022; 11:97-106. [PMID: 35879963 PMCID: PMC9307910 DOI: 10.2147/iprp.s354717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
Purpose Interprofessional collaboration between physicians and clinical pharmacists has been shown to improve patients’ outcome by reduce medical errors, costs and patient adherence. Thus, the purpose of this study was to investigate the medical doctors’ perceptions, expectations, experiences, and perceived barriers regarding clinical pharmacists in Wad Medani. Methods A cross-sectional study was conducted at five major hospitals in Wad Medani, between April and June 2021 using a self-administered questionnaire. The questionnaire was distributed among 178 physicians. The questionnaire consists of four sections, in addition to a demographic section. These four sections measure physicians’ perceptions, expectations, experience, and perceived barriers. Results A total of 178 physicians were enrolled in the study. Physicians were comfortable with clinical pharmacists detecting and preventing prescription errors (55.1%); providing patient education (56.3%). Generally, physicians had high expectations with agreement rate of all the items ranged from 51.7% to 85.4%. Most physicians (79.8%) agreed that clinical pharmacists were a reliable source of general and clinical drug information. 64.0% and 59.0% of physicians perceive the unclear responsibility of clinical pharmacists and the lack of physicians’ experience with clinical pharmacists were barriers that can hinder clinical pharmacists’ contributions, respectively. Conclusion Physicians had positive perceptions, expectations, and experiences with clinical pharmacists, and pointed out some barriers clinical pharmacists face. It was suggested that hospitals should recruit more clinical pharmacists to cover each unit within the hospital with clear job description and provide them CPD.
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Affiliation(s)
- Mohammed Ibrahim Mahmoud
- Department of Clinical Pharmacy & Pharmacy Practice, University of Gezira, Wad Medani, Gezira State, Sudan
| | - Maha Mirghani Maatoug
- Department of Clinical Pharmacy & Pharmacy Practice, University of Gezira, Wad Medani, Gezira State, Sudan
| | | | - Mirghani Yousif
- Department of Clinical Pharmacy & Pharmacy Practice, University of Gezira, Wad Medani, Gezira State, Sudan
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16
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Ahmed Shawki M, Ali Sabri N, Mohamed Ibrahim D, Maged Samady M, Samir Hamza M, Samir Hamza M. "The Impact of Clinical Pharmacist Implemented Education on the Incidence of Prescribing Errors in COVID-19 patients". Saudi Pharm J 2022; 30:1101-1106. [PMID: 35719834 PMCID: PMC9197561 DOI: 10.1016/j.jsps.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 06/11/2022] [Indexed: 10/28/2022] Open
Abstract
Background Clinical pharmacists have a vital role during COVID-19 pandemic in mitigating medication errors, particularly prescribing errors in hospitals. That is owing to the fact that prescribing errors during the COVID-19 pandemic has increased. Aim This study aimed to evaluate the impact of the clinical pharmacist on the rate of prescribing errors on COVID-19 patients in a governmental hospital. Methods The study was a pre-post study conducted from March 2020 till September 2020. It included the pre-education phase P0; a retrospective phase where all the prescription for COVID-19 patients were revised by the clinical pharmacy team and prescription errors were extracted. Followed by a one-month period; the clinical pharmacy team prepared educational materials in the form of posters and flyers covering all prescribing errors detected to be delivered to physicians. Then, the post-education phase P1; all prescriptions were monitored by the clinical pharmacy team to assess the rate and types of prescribing errors and the data extracted was compared to that from pre-education phase. Results The number of prescribing errors in P0 phase was 1054 while it was only 148 in P1 Phase. The clinical pharmacy team implemented education phase helped to significantly reduce the prescribing errors from 14.7/1000 patient-days in the P0 phase to 2.56 /1000 patient-days in the P1 phase (p-value <0.001). Conclusion The clinical pharmacist significantly reduced the rate of prescribing errors in patients with COVID-19 which emphasizes the great role of clinical pharmacists' interventions in the optimization of prescribing in these stressful conditions.
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Affiliation(s)
- May Ahmed Shawki
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Nagwa Ali Sabri
- Clinical Pharmacy Department, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Maged Samady
- MSc degree of Hospital Management and Logistics, General Manager of New Cairo Hospital, Cairo, Egypt
| | - Marwa Samir Hamza
- Clinical Pharmacy Practice Department, Faculty of Pharmacy, The British University in Egypt, El-Sherouk City, Cairo, Egypt
| | - Marwa Samir Hamza
- Clinical Pharmacy Practice Department, Faculty of Pharmacy, The British University in Egypt, El-Sherouk City, Cairo, Egypt
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17
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Kukielka E, Jones R. Medication Safety in the Emergency Department: A Study of Serious Medication Errors Reported by 101 Hospitals From 2011 to 2020. PATIENT SAFETY 2022. [DOI: 10.33940/data/2022.3.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Although serious medication errors are uncommon, accounting for only 0.4% (166 of 46,568) of medication errors reported to the Pennsylvania Patient Safety Reporting System (PA-PSRS) in 2020, their effects can be devastating for patients and their loved ones.
Methods: We queried PA-PSRS for reports of serious events classified as medication errors that occurred in the emergency department (ED) from January 1, 2011, to December 31, 2020. We performed a descriptive analysis to identify trends among patient sex, patient age, event harm score, event day of the week, and event time of day. We also manually coded and analyzed events based on the prescribed medication(s) and medication class(es), stage of the medication-use process at which the error occurred, and medication error type.
Results: We identified 250 reports of serious medication error events in PA-PSRS that occurred in the ED from 2011 to 2020. Reports more often specified that the patient was female (61.2%; 153 of 250), and patients ranged in age from 8 months to 96 years, with a median patient age of 55 years. Events were significantly more likely to occur Friday through Sunday versus Monday through Thursday (p = .0214) and in the p.m. hours versus a.m. hours, (p = .0007). The most common prescribed medications mentioned in reports were epinephrine, insulin, hydromorphone, sodium chloride, heparin, propofol, diltiazem, ketamine, and morphine. Events occurred most often at the prescribing stage of the medication-use process (42.0%; 105 of 250), and the most common medication error type was a wrong dose (42.0%; 105 of 250).
Conclusion: Potential safety strategies to consider to reduce the risk of medication errors in the ED include stocking epinephrine autoinjectors, using clinical decision support at the ordering/prescribing stage of the process, and adding an emergency medicine pharmacist as part of an interdisciplinary emergency medicine team.
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18
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Dietrich SK, Bushong BT, Schneider-Smith EA, Mixon MA. Emergency medicine pharmacist interventions reducing exposure to costs (EMPIRE-C). Am J Emerg Med 2022; 54:178-183. [DOI: 10.1016/j.ajem.2022.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/23/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022] Open
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19
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Abdel-Qader DH, Saadi Ismael N, Al Meslamani AZ, Albassam A, El-Shara' AA, Lewis PJ, Hamadi S, Al Mazrouei N. The Role of Clinical Pharmacy in Preventing Prescribing Errors in the Emergency Department of a Governmental Hospital in Jordan: A Pre-Post Study. Hosp Pharm 2021; 56:681-689. [PMID: 34732922 DOI: 10.1177/0018578720942231] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Clinical pharmacists have a vital role in intercepting prescribing errors (PEs) but their impact within a Jordanian hospital emergency department (ED) has never been studied. Objective: To evaluate the impact of clinical pharmacy services on PEs and assess predictors of physicians' acceptance of clinical pharmacists' interventions. Setting: This study was conducted in the ED of the largest governmental hospital in Jordan. Method: This was a pre-post study conducted in October and November 2019 using a disguised observational method. There were 2 phases: control phase (P0) with no clinical interventions, and active phase (P1) where clinical pharmacists prospectively intervened upon errors. The clinical significance of errors was determined by a multidisciplinary committee. The SPSS software version 24 was used for data analysis. Main Outcome Measure: PEs incidence, type, severity, and predictors for physicians' acceptance. Results: Of 18003 patients, 8732 were included in P0 and 9271 in P1. PEs incidence decreased from 24.6% to 5.4%. Contraindication, drug selection, and dosage form error types were significantly reduced from 32.6%, 9.1%, and 3.7% (P0) to 12.6%, 0.0%, and 0.0% (P1), respectively. Albeit not statistically significant, drug-drug interaction, drug frequency, and allergy error types were reduced from 4.9%, 3.1%, and 0.1% to 4.5%, 2.5%, and 0.0%, respectively. Significant and serious errors were significantly reduced from 68.7% and 3.0% (P0) to 8.9% and 1.8% (P1), respectively. During P1, most errors were minor (89.3%, 1574/1763), and lethal errors ceased. Predictors for physicians' acceptance were: significant errors (OR 3.1; 95% CI 2.6-4.3; P = 0.03) and non-busy physicians (OR 2.1; 95% CI 1.6-2.7; P = 0.04). Conclusion: Clinical pharmacists significantly reduced PEs in the ED by 76%; most of interventions were significant. Policymakers are advised to implement active clinical pharmacy in the ED.
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Affiliation(s)
- Derar H Abdel-Qader
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | | | - Ahmad Z Al Meslamani
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | | | - Asma' A El-Shara'
- Department of Clinical Sciences, Philadelphia University, Amman, Jordan
| | - Penny J Lewis
- Division of Pharmacy & Optometry, The University of Manchester, UK
| | - Salim Hamadi
- Department of Pharmacology and Biomedical Sciences, University of Petra, Amman, Jordan
| | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, UAE
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20
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Posen A, Benken S, Kaluzna SD, Sabouni M, Miglo J, Cai J, Gimbar RP. Poor guideline adherence in a real-world evaluation of hypertensive emergency management. Am J Emerg Med 2021; 51:46-52. [PMID: 34673475 DOI: 10.1016/j.ajem.2021.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/13/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The American College of Cardiology and American Heart Association define hypertensive emergency (HTN-E) as a systolic blood pressure greater than 180 mmHg or a diastolic blood pressure greater than 120 mmHg with evidence of end-organ damage (EOD). Based on expert opinion, current guidelines recommend antihypertensive therapy to reduce blood pressure (BP) at specific hourly rates to reduce progression of EOD, outlined by four criteria. Our goal was to describe compliance with guideline recommendations for early management of HTN-E and to analyze safety outcomes related to pharmacologic intervention. METHODS This was a retrospective chart review including patients presenting to the emergency department with HTN-E between September 2016 and August 2020. We excluded patients with a compelling indication for altered therapeutic goals (e.g. acute aortic dissection, hemorrhagic or ischemic stroke, and pheochromocytoma). The primary outcome was complete adherence with guideline recommendations in the first 24 h. RESULTS Of 758 screened records, 402 were included. Mean age was 54 years and majority Black race (72%). Overall, total adherence was poor (<1%): 30% received intravenous therapy within 1 h, 64% achieved 1-h BP goals, 44% achieved 6-h goals, and 9% had appropriate 24-h maintenance BP. Hypotensive events (N = 67) were common and antihypertensive-associated EOD (N = 21) did occur. Predictors of hypotension include treatment within 1 h and management with continuous infusion medication. CONCLUSIONS Current practice is poorly compliant with guideline criteria and there are risks associated with recommended treatments. Our results favor relaxing the expert opinion-based recommendations.
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Affiliation(s)
- Andrew Posen
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, S Wood St. 164 Pharm, MC 886, Chicago, IL 60612, United States; University of Illinois Hospital and Health Sciences System, 1740 W Taylor, St. Chicago, IL 60612, United States.
| | - Scott Benken
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, S Wood St. 164 Pharm, MC 886, Chicago, IL 60612, United States; University of Illinois Hospital and Health Sciences System, 1740 W Taylor, St. Chicago, IL 60612, United States.
| | - Stephanie Dwyer Kaluzna
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, S Wood St. 164 Pharm, MC 886, Chicago, IL 60612, United States; University of Illinois Hospital and Health Sciences System, 1740 W Taylor, St. Chicago, IL 60612, United States.
| | - Murrah Sabouni
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, S Wood St. 164 Pharm, MC 886, Chicago, IL 60612, United States.
| | - Jane Miglo
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, S Wood St. 164 Pharm, MC 886, Chicago, IL 60612, United States.
| | - Jiaqi Cai
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, S Wood St. 164 Pharm, MC 886, Chicago, IL 60612, United States.
| | - Renee Petzel Gimbar
- University of Illinois at Chicago, College of Pharmacy, Department of Pharmacy Practice, S Wood St. 164 Pharm, MC 886, Chicago, IL 60612, United States; University of Illinois Hospital and Health Sciences System, 1740 W Taylor, St. Chicago, IL 60612, United States.
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21
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Ortmann MJ, Johnson EG, Jarrell DH, Bilhimer M, Hayes BD, Mishler A, Pugliese RS, Roberson TA, Slocum G, Smith AP, Yabut K, Zimmerman DE. ASHP Guidelines on Emergency Medicine Pharmacist Services. Am J Health Syst Pharm 2021; 78:261-275. [PMID: 33480409 DOI: 10.1093/ajhp/zxaa378] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Daniel H Jarrell
- Department of Pharmacy, Banner - University Medical Center Tucson, Tucson, AZ.,Department of Pharmacy Practice and Science, The University of Arizona, Tucson, AZ
| | - Matt Bilhimer
- Department of Pharmacy, Olathe Medical Center, Olathe, KS
| | - Bryan D Hayes
- Department of Emergency Medicine, Harvard Medical School, Boston, MA.,Department of Pharmacy, Massachusetts General Hospital, Boston, MA
| | - Aimee Mishler
- Department of Pharmacy, Valleywise Health, Phoenix, AZ
| | - Robert S Pugliese
- Department of Pharmacy, Thomas Jefferson University Hospital, Philadelphia, PA.,Department of Pharmacy, Thomas Jefferson University, Philadelphia, PA
| | - Taylor A Roberson
- Department of Pharmacy, OhioHealth Grant Medical Center, Columbus, OH
| | - Giles Slocum
- Department of Pharmacy and Department of Emergency Medicine, Rush University Medical Center, Chicago, IL
| | - Andrew P Smith
- Department of Pharmacy, Scripps Mercy Hospital, San Diego, CA
| | - Katie Yabut
- Department of Pharmacy, Legacy Mount Hood Medical Center, Portland, OR
| | - David E Zimmerman
- Department of Pharmacy, Duquesne University School of Pharmacy, Pittsburgh, PA.,Department of Pharmacy, UPMC-Mercy, Pittsburgh, PA
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22
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Bakhshi F, Mitchell R, Nikbakht Nasrabadi A, Javadi M, Varaei S. Clinician attitude towards safety in medication management: a participatory action research study in an emergency department. BMJ Open 2021; 11:e047089. [PMID: 34548346 PMCID: PMC8458336 DOI: 10.1136/bmjopen-2020-047089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Edication management is a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care and safety. This paper explores clinicians' attitudes towards medication management which is both open to influence and strongly linked to successful changes in mediation behaviour. We aimed to investigate effects of engaging in participatory action research to improve emergency medicine clinicians' attitudes to safety in medication management. SETTING Emergency department of one university affiliated hospital. PARTICIPANTS A total of 85 clinicians including nurses and physicians partook as participants. Eight managers and clinicians participated as representatives. DESIGN Data are drawn from two-cycle participatory action research. Initially, a situation analysis on the current medication management and clinician views regarding medication management was conducted using three focus groups. Evaluation and reflection data were obtained through qualitative interviews. All qualitative data were analysed using content analysis. RESULTS Clinicians initially expressed negative attitudes towards existing and new plans for medication management, in that they were critical of current medication-related policy and procedures, as well as wary of the potential relevance and utility of potential changes to medication management. Through the action research, improvement actions were implemented including interprofessional courses, pharmacist-led interventions and the development of new guidelines regarding medication management. Participants and their representatives were engaged in all participatory action research stages with different levels of involvement. Extracted results from evaluation and reflection stages revealed that by engaging in the action research and practice new interventions, clinicians' attitude towards medication management was improved. CONCLUSIONS The results support the impact of participatory action research on enhancing clinicians' positive attitudes through their involvement in planning and implementing safety enhancing aspects of medication management.
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Affiliation(s)
- Fatemeh Bakhshi
- Department of Nursing, Research Center for Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran (the Islamic Republic of)
- Macquarie Business school, Department of Management, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Macquarie Business school, Department of Management, Macquarie University, Sydney, New South Wales, Australia
| | - Alireza Nikbakht Nasrabadi
- School of Nursing and Midwifery, Medical-Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Mostafa Javadi
- Research center for Nursing and Midwifery care, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran (the Islamic Republic of)
| | - Shokoh Varaei
- School of Nursing and Midwifery, Medical-Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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O’Brien ME, Fuh L, White BA, Bowman JK, Hayes BD. Effect of pharmacist education and intervention on ketorolac prescribing in an emergency department. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2021. [DOI: 10.1002/jppr.1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Lanting Fuh
- Department of Pharmacy Massachusetts General Hospital Boston USA
| | - Benjamin A. White
- Department of Emergency Medicine Massachusetts General Hospital Boston USA
- Department of Emergency Medicine Harvard Medical School Boston USA
| | - Jason K. Bowman
- Department of Emergency Medicine Massachusetts General Hospital Boston USA
- Department of Emergency Medicine Harvard Medical School Boston USA
| | - Bryan D. Hayes
- Department of Pharmacy Massachusetts General Hospital Boston USA
- Department of Emergency Medicine Harvard Medical School Boston USA
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24
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Acquisto NM, Slocum GW, Bilhimer MH, Awad NI, Justice SB, Kelly GF, Makhoul T, Patanwala AE, Peksa GD, Porter B, Truoccolo DMS, Treu CN, Weant KA, Thomas MC. Key articles and guidelines for the emergency medicine clinical pharmacist: 2011-2018 update. Am J Health Syst Pharm 2021; 77:1284-1335. [PMID: 32766731 DOI: 10.1093/ajhp/zxaa178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To summarize recently published research reports and practice guidelines on emergency medicine (EM)-related pharmacotherapy. SUMMARY Our author group was composed of 14 EM pharmacists, who used a systematic process to determine main sections and topics for the update as well as pertinent literature for inclusion. Main sections and topics were determined using a modified Delphi method, author and peer reviewer groups were formed, and articles were selected based on a comprehensive literature review and several criteria for each author-reviewer pair. These criteria included the document "Oxford Centre for Evidence-based Medicine - Levels of Evidence (March 2009)" but also clinical implications, interest to reader, and belief that a publication was a "key article" for the practicing EM pharmacist. A total of 105 articles published from January 2011 through July 2018 were objectively selected for inclusion in this review. This was not intended as a complete representation of all available pertinent literature. The reviewed publications address the management of a wide variety of disease states and topic areas that are commonly found in the emergency department: analgesia and sedation, anticoagulation, cardiovascular emergencies, emergency preparedness, endocrine emergencies, infectious diseases, neurology, pharmacy services and patient safety, respiratory care, shock, substance abuse, toxicology, and trauma. CONCLUSION There are many important recent additions to the EM-related pharmacotherapy literature. As is evident with the surge of new studies, guidelines, and reviews in recent years, it is vital for the EM pharmacist to continue to stay current with advancing practice changes.
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Affiliation(s)
- Nicole M Acquisto
- Department of Pharmacy and Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY
| | - Giles W Slocum
- Department of Pharmacy, Rush University Medical Center, Chicago, IL
| | | | - Nadia I Awad
- Department of Pharmacy, Robert Wood Johnson University Hospital, New Brunswick, NJ
| | | | - Gregory F Kelly
- Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Therese Makhoul
- Department of Pharmacy, Santa Rosa Memorial Hospital, Santa Rosa, CA
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Gary D Peksa
- Department of Pharmacy, Rush University Medical Center, Chicago, IL
| | - Blake Porter
- Department of Pharmacy, University of Vermont Medical Center, Burlington, VT
| | | | - Cierra N Treu
- Department of Pharmacy, NewYork Presbyterian-Brooklyn Methodist Hospital, Brooklyn, NY
| | - Kyle A Weant
- Medical University of South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC
| | - Michael C Thomas
- McWhorter School of Pharmacy, Samford University, Birmingham, AL
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25
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Poe RCJ, Fouth GW, Revak EN. Gap analysis of emergency department pharmacy services within a multistate, multihospital integrated health system. Am J Health Syst Pharm 2021; 78:1962-1967. [PMID: 33999119 DOI: 10.1093/ajhp/zxab189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The purpose of this project was to identify current emergency medicine pharmacist (EMP) practices at each site and create a plan to integrate, align, and optimize pharmacy services across the health system with established American Society of Health-System Pharmacists (ASHP) best practices for EMPs. SUMMARY Initially, a review was performed of the literature and guidelines from professional organizations relating to EMPs. A survey was distributed across the health system to assess EMP services at each site, and survey results were used to conduct a gap analysis, comparing current practices to established ASHP best practices. The survey identified unique components of each site, including the patient population served and EMP coverage and responsibilities. To prioritize, design, and execute the gap closure plan, a systemwide EMP workgroup was created. The workgroup formulated a toolkit to provide pharmacy leaders, pharmacy informatics, and EMPs resources to facilitate alignment on the prioritized areas. CONCLUSION This project successfully identified gaps in EMP services and alignment with best practices across the health system. Through prioritization of essential EMP responsibilities, workflow standardization, and EHR optimization, a gap closure plan was formulated to align with ASHP best practices.
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Affiliation(s)
- Riley C J Poe
- Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | | | - Ellen N Revak
- Aurora St. Luke's Medical Center, Milwaukee, WI, USA
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26
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Rech MA, Adams W, Smetana KS, Gurnani PK, Van Berkel Patel MA, Peppard WJ, Hammond DA, Flannery AH. PHarmacist Avoidance or Reductions in Medical Costs in Patients Presenting the EMergency Department: PHARM-EM Study. Crit Care Explor 2021; 3:e0406. [PMID: 33912836 PMCID: PMC8078282 DOI: 10.1097/cce.0000000000000406] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To comprehensively classify interventions performed by emergency medicine clinical pharmacists and quantify cost avoidance generated through their accepted interventions. DESIGN A multicenter, prospective, observational study was performed between August 2018 and January 2019. SETTING Community and academic hospitals in the United States. PARTICIPANTS Emergency medicine clinical pharmacists. INTERVENTIONS Recommendations classified into one of 38 intervention categories associated with cost avoidance. MEASUREMENTS AND MAIN RESULTS Eighty-eight emergency medicine pharmacists at 49 centers performed 13,984 interventions during 917 shifts that were accepted on 8,602 patients and generated $7,531,862 of cost avoidance. The quantity of accepted interventions and cost avoidance generated in six established categories were as follows: adverse drug event prevention (1,631 interventions; $2,225,049 cost avoidance), resource utilization (628; $310,582), individualization of patient care (6,122; $1,787,170), prophylaxis (24; $22,804), hands-on care (3,533; $2,836,811), and administrative/supportive tasks (2,046; $342,881). Mean cost avoidance was $538.61 per intervention, $875.60 per patient, and $8,213.59 per emergency medicine pharmacist shift. The annualized cost avoidance from an emergency medicine pharmacist was $1,971,262. The monetary cost avoidance to pharmacist salary ratio was between $1.4:1 and $10.6:1. CONCLUSIONS Pharmacist involvement in the care of patients presenting to the emergency department results in significant avoidance of healthcare costs, particularly in the areas of hands-on care and adverse drug event prevention. The potential monetary benefit-to-cost ratio for emergency medicine pharmacists is between $1.4:1 and $10.6:1.
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Affiliation(s)
- Megan A Rech
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL
| | - William Adams
- Department of Biostatistics, Loyola University, Maywood, IL
| | - Keaton S Smetana
- Department of Pharmacy, Ohio State University Medical Center, Columbus, OH
| | - Payal K Gurnani
- Department of Pharmacy, Rush University Medical Center, Chicago, IL
- Department of Internal Medicine, Rush Medical College, Chicago, IL
| | | | - William J Peppard
- Department of Pharmacy, Froedtert Hospital, Milwaukee, WI
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Drayton A Hammond
- Department of Pharmacy, Loyola University Medical Center, Maywood, IL
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL
- Department of Biostatistics, Loyola University, Maywood, IL
- Department of Pharmacy, Ohio State University Medical Center, Columbus, OH
- Department of Pharmacy, Rush University Medical Center, Chicago, IL
- Department of Internal Medicine, Rush Medical College, Chicago, IL
- Department of Pharmacy, Erlanger Medical Center, Chattanooga, TN
- Department of Pharmacy, Froedtert Hospital, Milwaukee, WI
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
| | - Alexander H Flannery
- Department of Pharmacy, University of Kentucky HealthCare, Lexington, KY
- Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, KY
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27
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Anzan M, Alwhaibi M, Almetwazi M, Alhawassi TM. Prescribing errors and associated factors in discharge prescriptions in the emergency department: A prospective cross-sectional study. PLoS One 2021; 16:e0245321. [PMID: 33434202 PMCID: PMC7802932 DOI: 10.1371/journal.pone.0245321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/29/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Evidence regarding the prevalence of medication prescribing errors (PEs) and potential factors that increase PEs among patients treated in the emergency department (ED) are limited. This study aimed to explore the prevalence and nature of PEs in discharge prescriptions in the ED and identify potential risk factors associated with PEs. METHODS This was a prospective observational cross-sectional study in an ambulatory ED in a tertiary teaching hospital. Data were collected for six months using a customized reporting tool. All patients discharged from ED with a discharged prescription within the study period were enrolled in this study. RESULTS About 13.5% (n = 68) of the 504 prescriptions reviewed (for 504 patients) had at least one error. Main PEs encountered were wrong dose (23.2%), wrong frequency (20.7%), and wrong strength errors (14.6%). About 36.8% of identified PEs were related to pediatric prescriptions, followed by the acute care emergency unit (26.5%) and the triage emergency unit (20.6%). The main leading human-related causes associated with PEs were lack of knowledge (40.9%) followed by an improper selection from a computer operator list (31.8%). The leading contributing systems related factors were pre-printed medication orders (50%), lack of training (31.5%), noise level (13.0%), and frequent interruption of prescriber and distraction (11.1%). Prescribers' involved with the identified errors were resident physicians (39.4%), specialists (30.3%), and (24.4%) were made by general practitioners. Physicians rejected around 12% of the pharmacist-raised recommendations related to the identified PEs as per their clinical judgment. CONCLUSION PEs in ED setting are common, and multiple human and systems-related factors may contribute to the development of PEs. Further training to residents and proper communication between the healthcare professionals may reduce the risk of PEs in ED.
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Affiliation(s)
- Mona Anzan
- Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mansour Almetwazi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M. Alhawassi
- Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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28
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Farmer BM, Cole JB, Olives TD, Farrell NM, Rao R, Nelson LS, Mazer-Amirshahi M, Stolbach AI. ACMT Position Statement: Medication Administration and Safety During the Response to COVID-19 Pandemic. J Med Toxicol 2020; 16:481-483. [PMID: 32617893 PMCID: PMC7332309 DOI: 10.1007/s13181-020-00794-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Brenna M Farmer
- Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Jon B Cole
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, USA
| | - Travis D Olives
- Minnesota Poison Control System, Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA
| | - Natalija M Farrell
- Department of Pharmacy, Boston Medical Center, Boston, MA, USA
- Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Rama Rao
- Weill Cornell Medicine-New York Presbyterian Hospital, New York, NY, USA
| | | | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center and Georgetown University School of Medicine, Washington, DC, USA
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29
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Clinical Pharmacists: Essential During a Poison Outbreak. J Med Toxicol 2020; 16:356-357. [DOI: 10.1007/s13181-020-00793-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022] Open
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30
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Mycyk MB. Addressing the vexing challenge of bleeding from oral anticoagulants in the ED. Am J Emerg Med 2020; 38:1209-1210. [DOI: 10.1016/j.ajem.2020.01.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/27/2020] [Indexed: 11/16/2022] Open
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31
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Emergency medicine clinical pharmacist's impact on ordering of vancomycin loading doses. Am J Emerg Med 2020; 38:823-826. [DOI: 10.1016/j.ajem.2019.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022] Open
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32
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Awad NI, Geib AJ, Roy A, Cocchio C, Bridgeman PJ. Protocol deviations in intravenous acetylcysteine therapy for acetaminophen toxicity. Am J Emerg Med 2020; 38:830-833. [DOI: 10.1016/j.ajem.2019.158405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/01/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022] Open
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Dooley M. Locking shields not swords: strengthening pharmacy and medicine partnerships for better patient care. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2019. [DOI: 10.1002/jppr.1629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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34
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Effect of Clinical Pharmacy Services in an Older Adult Emergency Medicine Unit on Unplanned Rehospitalization of Older Adults Admitted for Falls: MUPA-PHARM Study. J Am Med Dir Assoc 2019; 20:947-948. [DOI: 10.1016/j.jamda.2019.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 02/22/2019] [Indexed: 12/24/2022]
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35
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Cole JB, Knack SK, Karl ER, Horton GB, Satpathy R, Driver BE. Human Errors and Adverse Hemodynamic Events Related to "Push Dose Pressors" in the Emergency Department. J Med Toxicol 2019; 15:276-286. [PMID: 31270748 DOI: 10.1007/s13181-019-00716-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Though the use of small bolus doses of vasopressors, termed "push dose pressors," has become common in emergency medicine, data examining this practice are scant. Push dose pressors frequently involve bedside dilution, which may result in errors and adverse events. The objective of this study was to assess for instances of human error and adverse hemodynamic events during push dose pressor use in the emergency department. METHODS This was a structured chart and video review of all patients age ≥ 16 years undergoing resuscitation and receiving push dose pressors from a single center from January 2010 to November 2017. Push dose pressors were defined as intended intravenous boluses of phenylephrine (any dose) or epinephrine (≤ 100 mcg). RESULTS A total of 249 patients were analyzed. Median age was 60 years (range, 16-97), 58% were male, 49% survived to discharge. Median initial epinephrine dose was 20 mcg (n = 139, IQR 10-100, range 1-100); median phenylephrine dose was 100 mcg (n = 110, IQR 100-100, range 25-10,000). Adverse hemodynamic events occurred in 98 patients (39%); 30 in the phenylephrine group (27%; 95% CI, 19-36%), and 68 in the epinephrine group (50%; 95% CI, 41-58%). Human errors were observed in 47 patients (19%), including 7 patients (3%) experiencing dosing errors (all overdoses; range, 2.5- to 100-fold) and 43 patients (17%) with a documentation error. Only one dosing error occurred when a pharmacist was present. CONCLUSIONS Human errors and adverse hemodynamic events were common with the use of push dose pressors in the emergency department. Adverse hemodynamic events were more common than in previous studies. Future research should determine if push dose pressors improve outcomes and if so, how to safely implement them into practice.
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Affiliation(s)
- Jon B Cole
- Department of Emergency Medicine, Hennepin Healthcare, 701 Park Ave, Mail Code RL.240, Minneapolis, MN, 55415, USA.
| | - Sarah K Knack
- Department of Emergency Medicine, Hennepin Healthcare, 701 Park Ave, Mail Code RL.240, Minneapolis, MN, 55415, USA.,Duke University School of Medicine, Durham, NC, USA
| | - Erin R Karl
- University of Minnesota Medical School, Minneapolis, MN, USA
| | - Gabriella B Horton
- Department of Emergency Medicine, Hennepin Healthcare, 701 Park Ave, Mail Code RL.240, Minneapolis, MN, 55415, USA
| | - Rajesh Satpathy
- Department of Emergency Medicine, Hennepin Healthcare, 701 Park Ave, Mail Code RL.240, Minneapolis, MN, 55415, USA
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin Healthcare, 701 Park Ave, Mail Code RL.240, Minneapolis, MN, 55415, USA
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Sin B, Ciaramella C, Stein G, Butel S, Thompson H, de Souza S, DiGregorio R. Implementation of an Advanced Pharmacy Practice Model in the Emergency Department. J Pharm Pract 2019; 33:481-490. [PMID: 30636511 DOI: 10.1177/0897190018819412] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE The objective of this retrospective descriptive study was to quantify clinical activities performed by pharmacists in an advanced pharmacy practice model in the emergency department (ED). METHODS Data from January 2015 to August 2017 extracted from the department of pharmacy's electronic documentation system and the hospital's electronic medical record were collected and reviewed. Cost savings was derived from the system with adaptation from the previous literature and had been validated by our institution's administration as an acceptable reflection of the impact for activity. RESULTS The ED pharmacy team participated in a total of 4106 clinical activities that resulted in a cumulative cost avoidance of $5 387 679. Overall, the most common clinical activities that the pharmacy team provided included pharmacotherapy consult (63.3%) and response to medical emergencies (20.7%). A total of 16 219 medication orders placed by ED clinicians were prospectively reviewed and 379 interventions were accepted by ED clinicians. Turnaround times for medication verification in median (interquartile range [IQR]) for 2015, 2016, and 2017 were 2 minutes (1-6 minutes), 3 minutes (1-6 minutes), and 2 minutes (1-5 minutes), respectively. A total of 14 peer-reviewed publications, primarily based on pharmacy practice or use of pharmacotherapy for acute pain, were published by a research program led by the ED pharmacotherapist. CONCLUSION We created and implemented an advanced practice model tailored to our institution's needs. The model maximized opportunities for pharmacists to provide direct patient care, practice at the top of their license, and encouraged the safe and effective use of medications.
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Affiliation(s)
- Billy Sin
- Mount Sinai Queens, Long Island City, NY, USA
| | - Christine Ciaramella
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Greg Stein
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Shalom Butel
- Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Holly Thompson
- Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sylvie de Souza
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA.,Department of Emergency Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Robert DiGregorio
- Department of Pharmacy Services, The Brooklyn Hospital Center, Brooklyn, NY, USA.,Department of Clinical Affairs, Arnold & Marie Schwartz College of Pharmacy, Long Island University, Brooklyn, NY, USA
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Kulwicki BD, Brandt KL, Wolf LM, Weise AJ, Dumkow LE. Impact of an emergency medicine pharmacist on empiric antibiotic prescribing for pneumonia and intra-abdominal infections. Am J Emerg Med 2018; 37:839-844. [PMID: 30097272 DOI: 10.1016/j.ajem.2018.07.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/24/2018] [Accepted: 07/26/2018] [Indexed: 12/19/2022] Open
Abstract
PURPOSE It is critical to engage ED providers in antimicrobial stewardship programs (ASP). Emergency medicine pharmacists (EMPs) play an important role in ASP by working with providers to choose empiric antimicrobials. This study aimed to determine the impact of an EMP on appropriate empiric antibiotic prescribing for community-acquired pneumonia (CAP) and intra-abdominal infections (CA-IAI). METHODS A retrospective cohort study was conducted evaluating adult patients admitted with CAP or CA-IAI. The primary outcome of this study was to compare guideline-concordant empiric antibiotic prescribing when an EMP was present vs. absent. We also aimed to compare the impact of an EMP in an early-ASP vs. established-ASP. RESULTS 320 patients were included in the study (EMP n = 185, no-EMP n = 135). Overall empiric antibiotic prescribing was more likely to be guideline-concordant when an EMP was present (78% vs. 61%, p = 0.001); this was true for both the CAP (95% vs. 79%, p = 0.005) and CA-IAI subgroups (62% vs. 44%, p = 0.025). Total guideline-concordant prescribing significantly increased between the early-ASP and established-ASP (60% vs. 82.5%, p < 0.001) and was more likely when an EMP was present (early-ASP: 68.3% vs. 45.8%, p = 0.005; established-ASP: 90.5% vs. 73.7%, p = 0.005). Patients receiving guideline-concordant antibiotics in the ED continued appropriate therapy upon admission 82.5% of the time vs. 18.8% if the ED antibiotic was inappropriate (p < 0.001). CONCLUSION The presence of an EMP significantly improved guideline-concordant empiric antibiotic prescribing for CAP and CA-IAI in both an early and established ASP. Inpatient orders were more likely to be guideline-concordant if appropriate therapy was ordered in the ED.
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Affiliation(s)
| | - Kasey L Brandt
- Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Lauren M Wolf
- Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Andrew J Weise
- Grand Rapids Emergency Medical Group, Grand Rapids, MI, USA
| | - Lisa E Dumkow
- Pharmaceutical Services, Mercy Health Saint Mary's, Grand Rapids, MI, USA.
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